Submit by Email
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Application for Employment
Please fill out the form below electronically for clarity and efficiency.
Personal Information
Last Name:
Address:
First Name:
City:
Initial:
How many years at current residence?
Date of Birth:
Phone Number:
Social Ins. Number:
Email Address:
Prov:
Postal Code:
If less than three years at current residence, please supply previous addresses below.
Address:
City:
Address:
Prov:
Postal Code:
City:
Prov:
Postal Code:
How many years at current residence?
How many years at current residence?
Phone Number:
Phone Number:
Email Address:
Email Address:
Education
Highest Grade Completed:
Last School Attended:
College/University Degree:
Country:
Driver License Information
Province:
License Number:
Class of Equipment
License Type:
Expiry Date:
Type of Equipment
Dates
(Van, Tank, Flat, Etc.)
(From - To)
Approx. # of Miles (Total)
Straight Truck
Tractor & Semi-Trailer
Tractor - Two Trailers
Other
Accident Record for the Past 3 Years or More
Dates
Nature of Accident
(Head-On, Rear-End, Upset,
Etc.)
Number of Fatalities
Number of Injuries
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Chemical Spill?
(Yes/No)
Yes
No
Yes
No
If Yes, Please Explain:
Has any license, permit or privilege been suspended or revoked?
If Yes, Please Explain:
Employment Record
Last Employer Name:
Address:
City:
Country:
Phone Number:
Position Held:
From:
Prov:
To:
Postal Code:
Salary:
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations while employed by the above employer?
Yes
No
Was the previous job position designated as a Safety sensitive function in any DOT regulated mode,
subject to alcohol and controlled substances testing requirements?
Yes
No
Last Employer Name:
Address:
City:
Country:
Phone Number:
Position Held:
From:
Prov:
To:
Postal Code:
Salary:
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations while employed by the above employer?
Yes
No
Was the previous job position designated as a Safety sensitive function in any DOT regulated mode,
subject to alcohol and controlled substances testing requirements?
Yes
No
Last Employer Name:
Address:
City:
Country:
Phone Number:
Position Held:
From:
Prov:
To:
Postal Code:
Salary:
Reason for Leaving:
Were you subject to Federal Motor Carrier Safety Regulations while employed by the above employer?
Yes
No
Was the previous job position designated as a Safety sensitive function in any DOT regulated mode,
subject to alcohol and controlled substances testing requirements?
Yes
No
Agreement
I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other
related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be
made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care
providers and other persons from all liability in responding to inquiries and releasing information in connection with my
application. In the event of employment, I understand that false or misleading information given in my application or interview(s)
may result in discharge. I understand also, that I am required to abide by all rules and regulations of the Company. I understand
that the information I provide regarding current and/or previous employers may be used, and those employer(s) will be
contacted, for the purpose of investigating my safety performance history. I understand that I have the right to:
- Review information provide by current / previous employers;
- Have errors and information corrected by the previous employers and for those previous employers to re-send the
corrected information to the prospective employer; and
- Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree
on the accuracy of the information.
Date:
Print Name:
This certifies that I completed this application, and all the entries on it and information in it are true and completed to best of my
knowledge.
Signature:
Criminal Record Search
Information provided to Raj Transport Ltd. will be held in accordance with The Personal Information Protection and Electronic
Documents Act. The company will take appropriate steps to ensure the security of your information and will not provide
information to another party except as approved by you, or to meet legal or legislated requirements.
Print Name:
Date of Birth:
I authorize Raj Transport Ltd. to retain, on file, the Criminal Record Search that I have provided as a condition of becoming an
approved driver within Raj Transport Ltd.
Date:
Signature:
Authorization to Request Driver Abstract
By my signature below, I hereby authorize Raj Transport Ltd. to request and obtain a driver's record/abstract on my behalf. I
understand while operating as an approved driver in Raj Transport Ltd., will request and obtain a current copy of my driver's
record/abstract each year.
License Number:
Date of Birth:
Province License Issued:
Date:
Print Name:
Signature:
